Folk Remedy-Associated Lead Poisoning in Hmong
Children -- Minnesota
Between January 1, and June 30, 1983, 35 children with lead
toxicity* were identified through routine screening by the St.
Paul,
Minnesota, Division of Public Health. Of these, 24 (69%) were
Hmong
refugees from Northern Laos. This represents a twofold to
threefold
increase in the number of Hmong children found to have lead
toxicity
in St. Paul compared with previous years. One source of lead
poisoning appears to be a Hmong folk remedy used for treating
infants
and children with fevers. A case report follows:
On May 3, 1983, a 6-month-old Hmong girl was found to have lead
poisoning (blood lead (BL) 60 ug/dl, erythrocyte protoporphyrin
263
ug/dl, hematocrit 38%) during screening for well-baby care. She
was
asymptomatic at the time. Her physical examination was
unremarkable.
X-ray films of the wrists and knees revealed dense provisional
zones
of calcification suggestive of lead deposits. No environmental
sources of lead, such as paint, could be identified after a
thorough
investigation of the family's home. After detailed questioning by
the
child's pediatrician, the parents admitted giving red and orange
powders to the baby as a cure for high fever. Laboratory analysis
of
the red powder showed a lead concentration of 8%. The infant was
given ethylene diamine tetraacetic acid (EDTA) chelation therapy as
an
outpatient.
Officials have been unable to obtain samples of the folk remedy
from the parents of other Hmong children with lead poisoning. The
remedy, generally refered to as "pay-loo-ah," consists of red and
orange powders, the composition and source of which often vary;
therefore, a more exact description of the material remains
difficult. Believed to have originated in China or Southeast Asia,
pay-loo-ah is fed to children as a cure for fever or rash. Samples
of
folk remedies were obtained from several Hmong households in the
community, and the U.S. Food and Drug Administration confirmed that
two contained lead (1% and 90%). Arsenic was found in three
samples
at concentrations of 70%-80%. These folk remedies were in wide use
and were easily available through local Asian food stores or Hmong
peddlers. To date, no cases of arsenic poisoning in the Hmong
children have been reported.
Reported by C Levitt, MD, Children's Hospital, St. Paul, D Paulson,
MD, K Duvall, MPH, J Godes, MPH, St. Paul Div of Public Health, AG
Dean, MD, State Epidemiologist, Minnesota State Dept of Health; J
Roberts, J Egenberger, Minneapolis District, US Food and Drug
Administration; Special Studies Br, Chronic Diseases Div, Center
for
Environmental Health, CDC.
Editorial Note
Editorial Note: Folk remedies have been known to cause lead
poisoning. A Mexican folk medicine, azarcon, has been reported to
cause lead poisoning in Mexican children in a number of
southwestern
states (1,2). Hmong refugees, who have emigrated from North Laos,
have an estimated total population over 50,000 and live in many
parts
of the United States, with the largest concentrations in Fresno,
Stockton, and San Diego, California, in addition to St. Paul.
Health-care providers for Hmong and Southeast Asians should be
aware of this unusual lead source. Screening for elevated blood
lead
levels is necessary to identify additional cases, because symptoms
of
lead toxicity generally have not been reported by the Hmong.
Reporting of cases to local or state health departments is
recommended. Appropriate health education will be necessary to
inform
the Hmong of the health consequences associated with this folk
remedy.
Lead poisoning resulting from folk remedies exemplifies the
need
to continue screening young children for lead toxicity. CDC
recommends routine screening of EP of all children between 6 months
and 5 years of age. An EP level of over the CDC recommendation of
50
ug/dl indicates either iron deficiency anemia or lead toxicity (3).
Lead toxicity should then be confirmed by a blood lead level.
References
Bose A, Vashistha K, O'Loughlin BJ. Azarcon por
Empacho--another
cause of lead toxicity. Pediatrics 1983;72:106-8.
CDC. Lead poisoning from lead tetroxide used as a folk
remedy--Colorado. MMWR 1982;30:647-8.
CDC. Preventing lead poisoning in young children: a statement
by
the Center for Disease Control. April 1978, page 4.
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